Inspection on 21/10/08 for 329 Fakenham Road

This inspection was carried out on 21st October 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

329 Fakenham Road 28/11/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 329 Fakenham Road 329 Fakenham Road Taverham Norwich NR8 6LG The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lella Hudson Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 329 Fakenham Road 329 Fakenham Road Taverham Norwich NR8 6LG 01603897046 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): bobj@newboundariesgroup.co.uk New Boundaries Community Services Ltd Name of registered manager (if applicable) Robert James Rolland Jenner Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home 329 Fakenham Road is a three bedroom bungalow situated in a residential area on a main road into Norwich. The service is owned and managed by New Boundaries Community Services Ltd which also own several other care homes around the Norwich area. The service provides care and accommodation for up to three adults with a learning disability who also have challenging behaviours. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home This report contains information gathered about the Home since the last Key Inspection, in November 2006. The Manager completed and returned the Annual Quality Assurance Assessment which contains a lot of information about the service, the improvements made and plans for further improvements. We also received completed surveys from two clients and one member of staff. We carried out a visit to the Page 7 of 30 Care Homes for Adults (18-65 years) Home on the 21st October 2008. The Manager was given a couple of days notice of the visit as it can be difficult to find a time when clients, staff and Manager are available. During the visit we spoke to two of the clients, to three of the staff and to the Manager. We also looked around the communal areas of the Home and looked at a selection of records. What the care home does well Care Homes for Adults (18-65 years) Page 8 of 30 The Home provides homely, comfortable accommodation for the three clients who live there. The clients are encouraged to personalise their own bedrooms as well as the communal areas. They are encouraged to take part in household tasks and are given support to do so when needed. The Home is well managed, in a way which puts the needs of the clients first. The staff and clients say that the Manager is approachable and easy to talk to. The health and personal care needs of the clients are Care Homes for Adults (18-65 years) Page 9 of 30 assessed and action taken to ensure that these are met. Health care professionals are involved as necessary. The staff support the clients to take part in a wide range of activities, including voluntary work, attending local church groups, working with the maintenance staff, leisure activities and also maintaining contact with family and friends. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 10 of 30 The care plans and risk assessments have improved since the last Inspection. Risks are now more clearly identified and assessed. The staffing situation has improved in the last few months with the employment of more permanent staff and therefore the reduced use of agency staff. The clients said that they prefer the permanent staff to be on duty. What the care home could do better Care Homes for Adults (18-65 years) Page 11 of 30 There is still a need to review some of the information in the care plans and risk assessments to ensure that they are providing clear guidance to staff about how to meet the clients needs. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lella Hudson CSCI CPC1 Care Homes for Adults (18-65 years) Page 12 of 30 Capital Park Fulbourn Cambridge CB21 5EX 01223 - 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 13 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The clients individual wishes and needs are assessed prior to them being offered a place at the Home. Evidence: One client has moved to the Home since the last Inspection. The client told us that he was invited to visit the Home prior to moving there and that lots of information was gathered before he decided to move in. The Home has appropriate admission procedures. Care Homes for Adults (18-65 years) Page 15 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The individual needs and wishes of the clients are included within the care plans. Risks are recognised and appropriately assessed. The clients are involved in making decisions about issues that affect their lives. Evidence: We looked at two of the care plans which includes risk assessments and daily records. One of the clients who spoke to us said that he has been involved in the development of his care plan and that his views were sought about how his care should be provided. He said that he is aware of the restrictions that are in place and of the reasons for these. One of the clients has difficulty with verbal communication and so the staff use objects of reference and other forms of communication. Information about these are in his care plan. Staff who spoke to us were aware of the care plans and the content. They gave consistent answers about the care provided to the clients. They are also aware of the Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: issues with regard to balancing the need to provide care and the rights of the clients to make their own decisions. The care plans contain information about a wide range of needs but in some examples the guidance for staff about how to meet the clients needs is not very detailed. The care plans show that risks are identified and that appropriate assessments have been carried out with regard to these. Again, the client who spoke to us was aware of the risk assessments in place with regard to his care. Two of the clients who spoke to us both told us that the staff ask their opinion about issues that affect them individually and the general running of the Home. One of the clients said that he meets with the Manager on a weekly basis to discuss how he feels about things that have happened in the previous week and to plan the forthcoming week. We were shown the system in place for looking after clients money. Appropriate records are kept of this and the clients are aware of the system in place. In June 2008 a member of staff admitted stealing clients money. The money has been refunded to the client by the organisation and the member of staff no longer works at the Home. Care Homes for Adults (18-65 years) Page 17 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Clients are supported individually to take part in a range of leisure and work activities. Clients receive support to maintain relationships with friends and family. Evidence: Clients told us about a range of activities that they like to do. These include shopping, working with the maintenance department of the organisation, voluntary work, formal day services and a range of leisure activities. Two of the clients told us that they get the support that they need to access activities but that occasionaly there is a lack of drivers. The Home has the use of a car. However, the Home is located close to the city of Norwich and there is good access to public transport. The clients are supported and encouraged to use local facilities. For example, most of the shopping is done at local shops and the clients use the local pub. Clients told us that they are able to have their own phones if they want them and that they have interenet access also so that they can keep in touch with friends and family. The Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Manager said that there are suitable restrictions on the use of the internet. The care plans contain information about the social and work interests that the clients have with information about how these can be supported. There is also information about how clients are supported to maintain contact with family and friends. The clients said that they enjoy their meals and that they are involved in planning menus, shopping and, sometimes, cooking. The care plan for one of the clients contains information about their particular dietary needs but this is not currently very clear. Care Homes for Adults (18-65 years) Page 19 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The personal and healthcare needs of the clients are met and medication is managed safely. Clients are supported to be as independent as they are able to be. Evidence: The care plans contain information about the clients personal and health care needs. These include information about physical and mental health needs. The clients told us that the staff provide good care and that they feel that their needs are met at the Home. The staff who spoke to us gave us consistent answers to questions about the care that individual clients need. They also gave examples of how clients have been supported recently to access healthcare professionals for particular problems. The clients, staff and the Manager all told us that agency staff are used at the Home on a fairly regular basis but that this has reduced recently. They all said that, when agency staff are used, they have mostly already worked at the Home and know the clients. Staff said that they receive mandatory training and some training about individual Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: needs of the clients, such as autism, mental health, aspergers syndrome. Some newer members of staff have not yet received this training but are confident that this will be provided. We looked at the medication system. Medication is stored securely and only staff who have received training are responsible for administering medication. We looked at the administration records for one of the clients and these are clear and have been completed properly. There is guidance available about the use of PRN (as required) medication. One of the clients said that he knows about his medication and that the staff explain any changes to him. He also said that the Manager had recently encouraged and supported him to chair his own meeting with a group of health professionals. He said that he had enjoyed doing this and that he feel much more confident as a result of the support that he had received to do so. Care Homes for Adults (18-65 years) Page 21 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Procedures and training for staff are in place to provide protection for the clients from abuse. Systems are in place and have been used to deal appropriately with allegations of abuse. Evidence: The clients told us that they know who to talk to and that the staff will sort things out for them. One of the clients said that he meets weekly with the Manager and he feels comfortable in raising any issues at that time. The Manager said that they record any issues that the clients raise and deal with them as complaints so that there is an audit. The Commission has not received any complaints about the Home since the last Inspection. As previously mentioned in this report, in June 2008 a member of staff admitted stealing money from a client. The Manager dealt with the situation appropriately and made the referral to the Safeguarding team and to the Protection of Vulnerable Adults list. Staff who spoke to us said that they have received training with regard to Safeguarding vulnerable adults and that they are aware of the procedure to follow if they have any concerns regarding possible abuse. The Manager said that he receives confirmation from the agency who provide staff on a temporary basis that their staff have got a Criminal Records Bureau disclosure and that they have appropriate training before they work at the Home. Care Homes for Adults (18-65 years) Page 22 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Home provides comfortable, homely accommodation that meets the needs of the clients. Evidence: The bungalow provides comfortable, homely accommodation for the three clients. Each client has their own bedroom with ensuite toilet and there is a communal bathroom, kitchen and lounge/diner. There is also a room used as an office and a staff sleep in room. The bungalow has a small enclosed garden. The clients are encouraged to help with the maintenance of the garden and to help with the general household tasks. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The staffing situation has improved and now meets the needs of the clients in a more consistent way. Clients like the staff and feel that their needs are met at the Home. Appropriate recruitment procedures are followed and training is provided for staff. Evidence: Both of the completed clients surveys that we received state that the staff treat them well and that they listen and act on what the clients say. Clients told us during the visit that they like the staff and that they are kind. They said that they encourage them to be independent but give support when needed. They said that staff always explain the reasons behind decisions that are made and involve them in making as many choices for themselves as possible. The Manager said that there are regular staff working at the Home and that they also use agency staff. He said that the agency staff have usually already worked at the Home. The staff and clients all said that there are more regular staff working at the Home now and that the use of agency staff has reduced. The clients said that they prefer the regular permanent staff to be on duty. We looked at the rotas and these confirm what the Manager had said about the fact that additional staff are on duty when the clients need additional support, for example, to go to appointments or to go out. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Staff said that they receive regular supervision from the Manager. They also said that they receive training on an ongoing basis. They have all attended the mandatory training and some have attended training that is specific to the needs of the clients, such as mental health. We looked at a selection of recruitment files and these show that approrpiate checks are carried out before a member of staff starts working at the Home. There is an induction programme in place for new staff. One of the staff put together a Start Here booklet for new or agency staff to assist them with understanding some basic information about working at the Home and supporting the clients. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Home is well managed in a way which puts the needs of the clients first. The views of the clients about the service that they receive are sought on a regular basis. The health and safety of the clients and staff is protected through regular maintenance of equipment and training of staff. Evidence: The Manager of this Home also manages two other small Homes within the organisation. The day to day management of the Home is shared between the Manager and the team leader. The team leader left in July 2008 and one of the staff is currently acting up in this position whilst recruitment takes place to replace this post. Staff and clients said that the Manager is approachable and operates an open door policy so that they feel comfortable talking to him at any time. One of the clients said that the Manager spends time with him on a weekly basis to discuss how things are going for him and any plans for the forthcoming week. Staff said that the Manager is always available and that he is very supportive. The Manager completed the Annual Quality Assurance Assessment which provided us Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: with lots of information about the service. The views of the clients are sought on a regular basis with regard to the quality of the service that they receive. Monthly visits, as per Regulation 26, are carried out by other Managers within the organisation and a report is written about any issues that need addressing. The organisation are reviewing who carries out these visits. We looked at a selection of records relating to Health and Safety issues and these show that regular maintenance and servicing of equipment takes place. Clients and staff said that fire drills take place. The fire risk assessment needs to be reviewed and updated Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 35 18 It is required that all staff receive training in subjects relevant to the needs of the clients 27/02/2009 To ensure that the needs of the clients are met Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 It is recommended that the care plans contain more detailed information, in some cases, about how to meet the clients needs. It is recommended that the information in the care plan for a particular client is made clearer with regard to their dietary needs so as to ensure that they receive consistent support. It is recommended that the fire risk assessment is reviewed and updated as necessary 2 17 3 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!